Evidence for flossing ‘weak’ and ‘unreliable’

New research has shown the evidence for flossing carries a ‘moderate to large potential for bias’

The evidence for flossing is ‘weak’, ‘very unreliable’ and carries ‘a moderate to large potential for bias’, new research shows.

An investigation by the Associated Press (AP) looked at ‘the most rigorous research’ over the last decade that compared the use of a toothbrush with the use of floss and a toothbrush, finding the evidence for flossing was of ‘very low quality’.

‘The difficulty is trying to get good evidence,’ Professor Damien Walmsley, scientific adviser to the British Dental Association, said.

‘People are different and large studies are costly to do … until then you can’t really say yes or no.

‘The best way to reduce your risk of tooth decay and gum disease is to brush teeth twice a day with a fluoride toothpaste, see the dentist regularly, cut back on sugar and limit the occasional sweet treat to meal times only.

‘Small interdental brushes are preferable for cleaning the area in between the teeth, where there is space to do so.

‘Floss is of little value unless the spaces between your teeth are too tight for the interdental brushes to fit without hurting or causing harm.’

Despite the research, US National Institutes of Health dentist, Tim Iafolla, recommend continuing to use floss: ‘It’s low risk, low cost,’ he said.

‘We know there’s a possibility that it works, so we feel comfortable telling people to go ahead and do it.’

Flossing recommendations

The NHS is now set to review its guidelines on flossing while PHE has said it will ‘consider these findings’.

The research focused on 25 studies and found that the majority of studies fail to demonstrate that flossing is effective at removing plaque, with calls now being made for more sophisticated trials into flossing.

‘Although there has been no conclusive proof to show that flossing is beneficial to oral health, there is evidence which shows that regular interdental cleaning, with interdental brushes plays an important role in our oral health routine,’ Michaela O’Neill, president of the BSDHT, said.

‘Tooth brushing alone only cleans three of the five surfaces of our teeth, so cleaning between our teeth is a critical part of good oral hygiene as it helps to prevent gum disease by removing plaque from any areas missed by brushing alone.

‘In recent years, gum disease has been linked with serious health conditions such as diabetes, stroke, cardiovascular disease, poor pregnancy outcomes and even dementia.